Blackwater fever

Blackwater fever (also knownn as malarial hemoglobinuria) is a rare but one of the most dangerous complications of malaria. It occurs almost exclusively with infections from the malaria parasite Plasmodium falciparum.

The symptoms of blackwater fever include a rapid pulse, high fever and chills, extreme prostration, a rapidly developing anemia and the passage of urine that is black or dark red in colour, hence the name of the disease. Acute kidney failure is common[1].

The distinctive colour of the urine is due to the presence of large amounts of hemoglobin, released during the extensive destruction of the patient’s red blood cells by malarial parasites. Patients frequently develop anemia because of the low numbers of red blood cells.

The presence of blood pigments in the blood serum usually produces jaundice early in the course of the disease.

Blackwater fever is most prevalent in Africa and Southeast Asia. Individuals with increased susceptibility, such as non-immune immigrants or individuals who are chronically exposed to malaria, are classic sufferers from the complication. Blackwater fever seldom appears until a person has had at least four attacks of malaria and has been in an endemic area for at least six months.

Historical epidemiological observations from the 20th century demonstrated variable patterns in prisoners in Andaman Islands (in the Indian Ocean), refugees in Macedonia, canal workers in Panama, expatriates in Rhodesia and Second World War soldiers (in Burma)[2].

Treatment for blackwater fever includes antimalarial drugs, whole-blood transfusions and complete bed rest, but even with these measures the mortality remains between 25 and 50 percent.

[1] Bodi et al: Black water fever associated with acute renal failure among Congolese children in Kinshasa in Saudi Journal of Kidney Diseases and Transplantation – 2014
[2] Shanks: The Multifactorial Epidemiology of Blackwater Fever in American Journal of Tropical Medicine and Hygiene – 2017